硬脑膜夹层导入云南白药对兔重型颅脑创伤后脑灌注和氧代谢的影响

Effects of Yunnan Baiyao through inner layer of cerebral dura mater on cerebral perfusion and oxygen metabolism in rabbits with severe traumatic brain injury

目的:探讨硬脑膜夹层应用云南白药对兔重型颅脑创伤后颅内压、脑血流量和脑代谢的影响。方法:将40只雄性新西兰大白兔分为硬脑膜夹层云南白药组(A组)、静脉甘露醇组(B组)、口服云南白药组(C组)和空白组(D组),制作重型颅脑创伤模型,行颅内压(ICP)监测,记录平均动脉压(MABP),计算脑灌注压(CPP),经颅多普勒(TCD)测定脑血流量(CBFV)。行股动脉和颈内静脉血气分析并计算动-颈内静脉血糖差(Glua-jv)、颈内静-动脉乳酸差(Lacjv-a)以及脑氧摄取率(CEO2),并进行数据比较。结果:治疗第12h至36h:A组ICP高于B组,CPP和CBFV低于B组(P<0.05)。第48h:A组ICP高于B组,但低于C组和D组;CPP低于B组,但高于C组和D组;CBFV高于C组和D组(P<0.05)。第60h至96h:A组ICP低于C组和D组,CPP高于C组和D组,而CBFV高于B组、C组和D组(P<0.05)。第36至96h:A组Glua-jv值高于B组、C组和D组,Lacjv-a值低于B组、C组和D组,CEO2值高于B组、C组和D组(P<0.05)。结论:硬脑膜夹层导入云南白药能在脑组织内达到有效治疗浓度,并通过增加脑组织的氧代谢效率改善脑细胞缺氧和能量代谢障碍,改善脑微循环,从而改善细胞性脑水肿,降低脑血流阻力,达到降低ICP,增加CPP和CBFV的作用。

Objective： To explore the effects of Yunnan Baiyao through inner layer of cerebral dura mater on cerebral perfusion and oxygen metabolism in rabbits with severe traumatic brain injury.Methods： 40 New Zealand white rabbits were divided into cerebral dura mater Yunnan Baiyao group（A group）,intravenous Mannitol group（B group）,oral Yunnan Baiyao group（C group） and control group（D group）.Record ICP,CPP and MABP.TCD measured cerebral blood flow volume.Monitor blood gas analysis in femoral artery and internal jugular venous bulb,accounting the CEO2 and D-values of glucose and lactic acid between artery and venous bulb.Results： From 12 to 36 hour after therapy： the ICP of A was highter than B,the CPP and CBFV were lower than B（P〈0.05）.At 48 hour： the ICP of A was highter than B and lower than C and D,the CPP was lower than B and highter than Cand D,while the CBFV of A was highter than C and D（P〈0.05）.From 60 to 96 hour： the ICP of A was lower than C and D,the CPP of A was highter than C and D,the CBFV of A was highter than B,C and D（P〈0.05）.From 36 to 96： The Glua-jv and CEO2 of A were highter than B,C and D,while the Lacjv-a was lower than B,C and D（P〈0.05）.Conclusion： Yunnan Baiyao through cerebral dura mater can reach effective treatment concentration in brain.By increasing the efficiency of oxygen metabolism of brain it can ameliorate brain cell hypoxia and energy metabolism handicap,adjust cerebral microcirculation,thus improves cytotoxic brain edema,decreases cerebral blood flow resistance,reduces ICP and increase the CPP and CBFV.